Survivors of childhood and adolescence cancers have significantly increased treatment related risk of late cardiovascular complications associated with cardiotoxic chemotherapy and radiotherapy compared to the general population. The aim of the study was to assess left ventricular function and heart failure risk in young cancer survivors.Design and method:
The study population consisted of adult childhood cancer survivors diagnosed before the age of 18 years (between 1987 and 2008) with hematologic malignancies and solid tumors. The patients had completed treatment, were in remission and did not present clinical symptoms of cardiac dysfunction at the time of the evaluation. Echocardiography was performed in 66 patients. Risk of congestive heart failure (CHF) by age 40 years and relative risk compared to siblings was calculated using validated CCSS-CHF tool based on patient's gender, age at cancer diagnosis, anthracycline and chest radiation exposure for 56 patients with hematologic malignancies.Results:
The mean age of 66 patients (56% females) at the time of assessment was 20.6 ± 2.2 years. The age at diagnosis averaged 12.1 ± 4.7 years. The mean time since the completion of treatment was 6.6 ± 4.7 years. The mean blood pressure was 118.5 ± 10.1/75.5 ± 5.6 mmHg. Echocardiographic parameters were as follows: ejection fraction (EF): 64 ± 5%, shortening fraction (SF:) 35.3 ± 8.8%, left ventricular mass (LVM): 124.3 ± 33.9 g LVM index: 73,1 ± 14,7 and E/A: 1.52 ± 0.33. Subclinical cardiac systolic dysfunction with FS < 29% was observed in 9.1%. In addition, concentric remodeling was detected in 4,8% of participants. The mean overall risk score of CHF was 5 points (high). 50% of patients with the history of hematologic malignancies were in high risk group of CHF (the relative risk of developing CHF compared to sibling control group is 33).Conclusions:
Subclinical cardiac systolic dysfunction is present in small proportion of the young adult survivors of childhood cancer despite relatively short time since the completion of treatment and relatively late age at exposure. The half of survivors of hematologic malignancies were in a high risk group of developing CHF by age 40 which warrants careful monitoring of these patients.